Phillip Ihaza

Clinical Radiotherapy
714/14

Case Study #4 Kaposi sarcoma of the left lateral foot.

1. General patient information and brief medical history (gender, age, medical/social history
relevant to diagnosis)
The patient is an 78 year old Nigerian male with a history of Stage 3 chronic kidney disease,
hypertension, chronic low back pain and benign prostatic hypertrophy.
The patient is married and lives with his spouse. He has family transport to appointments each day. He
has retired. He is a practicing Muslim. He denies any history of illicit drug use, alcohol use or tobacco
use. He does not have any hazardous materials exposure. There is no known family medical history of
malignancy, including Kaposi sarcoma. The patient is HIV negative and thus his Kaposi sarcoma is
endemic in nature.
The patient has no prior history of malignancy, and he has not had any definitive therapy including no
chemotherapy, radiation therapy, or surgery for this or any other condition.
2. Presenting signs/symptoms of patient
According to the patient and his son, he was first brought to medical attention due to the bilateral lower
extremity edema. Initially it was thought to be secondary to medications and amlodipine, which was
subsequently discontinued. It made no impact on the swelling. During his medical workup his physician
noted a quarter size lesion in his left foot, which was concerning, and referred the patient to
dermatology. Of note, the patient has noted several other lesions, which are unclearly of the same
pathophysiology; one located on the left aspect of the foot, another new lesion localized to his first and
second metatarsal web space. None of these lesions are painful in nature and no other lesions have
been biopsy proven Kaposi sarcoma. The patient also has ankle swelling, chronic cough and urinary
frequency.
3. Diagnostic/clinical detection and work up:
(imaging procedures, lab biopsy, surgery)
A shave biopsy of the lesion was obtained on May 27 of 2014, and was consistent with Kaposi sarcoma,
which extended into the deep margin of the biopsy. The patient did undergo an HIV test, which was
negative.
4. Diagnosis: (Histopathology, staging, grading)
Kaposi sarcoma of the left lateral foot.

5. Adjuvant Therapies: (surgery, Chemotherapy, Immunotherapy)

The patient is not receiving any adjuvant therapies.
6. Dose, fractionation scheme, treatment modality, beam arrangement, reduced/cone down
fields, etc.
The patient is receiving electron boost with a total dose of 5000 cGy, with a daily dose of 200 cGy. The
total number of fractions is 25. The treatment is using 9 Mev electrons with a 10 x 10 cone size. The
patient also has a 1 cm bolus in order to bring the dose closer to the surface.
7. Planning simulation/localization procedures: (immobilization devices, beam alignment,
anatomical borders, patient positioning, field sizes, target volumes, contrast media, skin
markers/tattoo.)
The patient is put in a feet first, right lateral decubitus position. The patient right leg is bent and his left
leg is fitted into a vac bag. The patient was given one AP tattoo for set up and marks are placed on the
vac bag to align the patient in the right position based on that AP tattoo.
8. Description of field borders in relation to bony anatomy, lymphatics (routes of spread), and
critical organs in treatment fields).
The superior border of the field is parallel and .3 cm to the ankle anteriorly. The lateral border are .3 cm
anteriorly to the ankle and it extends 5 cm towards the toes. The posterior border lies laterally to the
sole of the foot. Because the cancer is sarcoma, they tend to travel through the blood instead of the
lymphatics therefore a common area of spread is to the bone. There are no critical organs in the
treatment field due to the fact that the area being treated is the foot.
9. Treatment Unit Information: ( the patient will be treated using treatment type, stationary,
fixed field, arc, IMRT, SRS, number of ports, beam energy, beam alignment, treatment/gantry
angles, modifying devices, couch angle, etc.
The patient is receiving electron boost with a total dose of 5000 cGy, with a daily dose of 200 cGy. The
total number of fractions is 25. The treatment is using 9 Mev electrons with a 10 x 10 cone size. The
patient also has a 1 cm bolus in order to bring the dose closer to the surface.
Energy

Field size

Gantry angle

Coll Rtn.

SSD

MU

Couch angle

9E

10x10 cm

318.0 deg

32.0 deg

100

217 MU

320.0 deg

10. Explanation of treatment rationale for planning and field verification techniques:
The patient is being treated using a bolus and electrons. The rationale behind this choice is due to the
characteristics of electrons and x-rays. Electrons has a dmax that is much lower than that of x-rays.
Because of this characteristics it is more ideal for treating cancer that are superficial. And of course in
this case the tumor is on the surface of the skin on the patients left foot.

11. Organs at risk (OARs) and Tolerance Doses:

There are no organs at risk in this case because the area being treated in the left foot of the patient.
12. Acute and chronic possible radiation side effects/ complications and patient education
strategies for prevention, healing and comfort:
The side effects were explained to the patient and included, but were not limited to dermatitis, skin
hyperpigmentation, swelling, pain, potential injury to the surrounding bone.
13. Critical Thinking: Reflection of your interactions with the patient/family, clinical instructor(s),
issues and concerns:
The patient is very friendly and welcoming, he enters the room everyday greeting everyone with a smile
on his face. The patient does not seem to be affected emotionally to his cancer. The patient also appears
to be in good health. He is very family oriented which may have a positive impact on his quality of life.
And he has a son that is a doctor at Washington hospital center.
14. Proper citation of references using APA format.

1) Washington Hospital Center Medical chart, retrieved on July 16, 2014